TRACHEOTOMY AND LARYNGOT'OMY. The air-passages maybe opened in three dif ferent situations—namely, through the erico-thyroid membrane (see LARYNX), when the operation is termed laryngotteny; through the cricoid cartilage and the upper rings of the trachea, the operation being known as laryngo-t•acheotcmy; and through the tra chea, below the isthmus of the thyroid gland, constituting tracheotomy proper Laryngotomy and tracheotomy are more commonly performed than laryngo-tracheo tomy, to which no further allusion is required. Laryngotomy is more quickly and easily performed, especially in adult males, and is less dangerous; tracheotomy is a more difficult, tedious, and dangerous operation, but in some cases (as, for example, where there is any necessity for introducing the forceps) must be selected. It is unnecessary to enter into details regarding the modes of per-forming these operations. When the operation is completed, it large curved tube to breathe through is inserted in the aper ture, and secured round the neck with a tape. — A double tube or canula possesses many advantages, as, by withdrawing the inner one. which should slightly project at its lower extremity, it may be cleared of any mucus or blood that may have accumulated in it., without disturbing the wound. The caliber of the MI er t abs should always be sufficiently large to admit as much air as usually passes through the chink of the healthy glottis. The after-t•eatment is much the same.
as that required for wounds in the throat (q.v.). "Opening of the air-passages may be required," says Mr. Gray, "in any case of disease or injury which produces mechanical impediment to the passage of air from the mouth into the trachea; in cases of foreign substances in the air-passages; and in some cases of suspended animation where artificial inflation of the lungs cannot be performed by the ordinary means."—Holmes's System of Surgery, vol. ii. p. 317. In the case of a foreign body, its situation will determine the seat of the incision. Among the cases in which tracheotomy is, or may be, required, are cut throat, acute laryngitis, croup, diphtheria, chronic inflammation, and ulceration of the larynx, necrosis of the laryngeal cartilages; tumors, excrescences, or epithelial growth within the larynx; tumors (bronchocele, abscesses, etc ) external to the larynx or upper part of the trachea, and impeding respiration by pressure, etc. It has alsc been recommended, hut with little advantage, in hydrophobia, tetanus, and severe forms of epilepsy, with the view of relieving the suffocating spasms that occur in these diseases. Laryngotomy may advantageously be resorted to in cases of spasm of the glottis, in inflammation with oedema of the cellular tissue of the larynx, in inflamma Lion of the tongue, in tonsilitis and pharyngitis, if the swelling is so great as to produce symptoms of suffocation, etc.